Acute Lung Injury (ALI) is a syndrome characterized by acute, diffuse pulmonary capillary leak resulting in hypoxic respiratory failure. ALI imposes a significant public health burden with an incidence of 86 per 100,000 person years and a total number of deaths similar to breast cancer or HIV infection. Due to advances in medical care, the mortality rate for ALI has decreased from -70% to -40%. Patients who previously may have died now survive ALI; however, their recovery is often long and complicated. Research studying the long-term outcomes of these ALI survivors has become increasingly important. The present application is a third submission for a K24 award. The PI is a leader is patient -oriented research in critically ill patients especially those with ALI, and has an outstanding record of mentoring trainees. The goal of this proposal is to learn how existing ICU therapies can be used to minimize long-term physical and mental health morbidities and improve patients' functional status and quality of life after ALI. We propose to extend our existing NIH funded cohort study, which follows patients for 2 years after ALI, to allow 5-year follow-up. Specifically, we will study the epidemiology of muscle weakness, and symptoms of anxiety, depression and post-traumatic stress disorder at up to 5 years after ALI [Aims 1a and 2a] and the association of these sequelae with limitations in patients' physical function and quality of life. We will then determine the association of nutrition and corticosteroids in the ICU with long-term muscle weakness[Aim 1b]. We also will determine the association of delirium and corticosteroids in the ICU with long-term symptoms of post-traumatic stress disorder [Aim 2b]. A number of research opportunities exist for trainees. This research proposal describes a new cohort study of ALI patients who will be followed for 5 years. This research will provide new knowledge regarding the frequency of morbidities after ALI, their consequences for patients, and how nutrition, corticosteroids and delirium in the ICU may reduce or exacerbate these morbidities up to 5 years after ALI. The study will add to our infrastructure for trainees to participate in clinical research and to design future studies, including intervention studies, to improve outcomes in ALI patients.